Despite recent advances in cardiovascular prevention, the burden of cardiovascular disease remains very high. In fact, reduced patient adherence to cardioprotective drugs and inadequate control of major risk factors substantially limit the ability of evidence-based therapies to fully exert their potential favourable effects.
The European Society of Cardiology (ESC) is heavily engaged in promoting cardiovascular prevention and, in that respect, the recently released joint ESC–European Atherosclerosis Society (EAS) guidelines for the management of dyslipidaemias1 represent one of the latest and most relevant outputs for the medical community in Europe and worldwide.
Physicians will be challenged by several new perspectives in lipidic control introduced by these guidelines, ranging from risk assessment through pharmacological and non-pharmacological treatments as well therapeutic targets.
For the calculation of cardiovascular risk, the ESC–EAS guidelines refer to the SCORE algorithm, which has been extensively validated in Europe and considers only fatal atherosclerotic events. Values of high-density lipoprotein (HDL) cholesterol contribute to the risk estimate and four levels of risk are clearly identified. Individuals at very high risk are those with a >10 % probability of fatal events at 10 years; they include patients with previous ischaemic coronary or peripheral events, patients with type II diabetes, patients with moderate-to-severe chronic kidney disease, and those with a SCORE risk of >10 %. Patients at high risk are those with familial dyslipidaemia or elevated single risk factor. Patients at moderate risk are those with a SCORE risk of 1–5 %. The low-density lipoprotein (LDL) cholesterol target is set at <70 mg/dl for patients at very high risk, <100 mg/dl for those at high risk, and <115 mg/dl for those at moderate risk. These targets take into account current evidence from large randomised trials and meta-analyses documenting the benefits of very low cholesterol levels in primary and secondary prevention.
The ESC–EAS guidelines pay much attention to lifestyle changes to improve lipidic profile and recognise the role of nutraceuticals or functional foods – although no definitive data from intervention trials are yet available regarding these agents. Thus, phytosterols (which reduce cholesterol absorption), soy protein and red yeast rice can induce a modest but significant reduction of LDL levels and may be added to the diet to help control lipid profile.
The dissemination and implementation of these guidelines are key to combat cardiovascular disease, and scientific journals have a crucial role in enhancing the level of awareness within the medical community. European Cardiology plays a relevant part in that respect. I hope that you will find the contents of the current issue both interesting and informative.
- Reiner Z, Catapano AL, De Backer G, et al., ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS), Eur Heart J, 2011;32(14):1769–818. Guidelines available at: www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/g... (accessed 26 January 2012).
Crossref | PubMed